Vertical incomplete humerotomy with suture loop cerclages for humeral stem extraction and reimplantation in revision of shoulder arthroplasty

Extraction of well-fixed humeral implants during revision shoulder arthroplasty is difficult and prone to complications, especially humeral fracture (up to 12% in anatomic stem revision and 30% in reverse stem revision). To prevent this complication, we perform a vertical incomplete humerotomy (VIH) and use cerclages with suture loops and Nice knots for fixation. The purpose of this study is to describe the VIH technique with suture cerclage fixation, report the perioperative complications, and evaluate the radiological and clinical results outcomes. We performed a retrospective monocentric study of consecutive patients who underwent revision shoulder arthroplasty with a VIH at a single institution (2007-2022). A straight longitudinal humeral osteotomy was created posterior and parallel to the bicipital groove. This allows for extraction of the humeral stem and cement mantle. Osteotomy closure was performed with 2-6 cerclages with suture loops (Nice Loop; Tornier-Stryker, Kalamazoo, MI, USA) and a nonsliding knot ("Nice knot"). The primary outcome was assessment of intraoperative and postoperative complications. The secondary outcome was osteotomy healing at 6 months and clinical results at 2 years. A cohort of 47 patients (mean age, 67.34 years; range, 33-86 years) who underwent revision shoulder arthroplasty with VIH were analyzed, with a mean follow-up was 37.9 months. A total of 21 patients underwent hemiarthroplasty (HA), 11 total shoulder arthroplasty, and 15 reverse shoulder arthroplasty. There were 5 revisions to total shoulder arthroplasty, 26 revisions to reverse shoulder arthroplasty, 3 humeral stem revisions, and 13 revisions to spacers secondary to periprosthetic joint infection. One intraoperative humeral fracture occurred during stem removal. No postoperative complication related to the humerotomy occurred, and no patients required surgical revision secondary to the humerotomy. Primary osteotomy healing and callus formation were evident in all cases by 6 months. In 12 cases of periprosthetic joint infection, a second-stage revision was performed; there were 3 reinterventions (2 instability and 1 infection). At the last follow-up, 82% of patients were satisfied after the intervention; the mean Subjective Shoulder Value was 58%, and the visual analog scale score was 3.4/10. (1) VIH facilitates extraction of well-fixed cemented or uncemented humeral components and prevents iatrogenic humeral fractures in revision shoulder arthroplasty, and (2) suture fixation, using suture loops (Nice Loop; Tornier-Stryker) and a nonsliding knot ("Nice knot"), provides constant bone healing and is an alternative to wire for cerclage fixation of humerotomy.